Ganirelix Acetate Sosy
Generic: ganirelix acetate
250MCG/0.5ML
Gonadotropin Releasing Hormone Receptor Antagonist
Also known as:
GANIRELIX ACETATE SOSY 250MCG/0.5ML
ganirelix acetate sosy 250mcg/0.5ml
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Coverage by Insurer
Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.
Ambetter (Centene)
68 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
Signature Expanded Bronze with Atrium Health + Vision + Adult Dental
via Fyremadel |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Enhanced Asthma/COPD Care Silver $0 Rx Options
via Fyremadel |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Everyday Bronze
via Fyremadel |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Elite Bronze
via Fyremadel |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Clear Silver with $0 Insulin Options
via Fyremadel |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Signature Expanded Bronze
via Fyremadel |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Signature Silver
via Fyremadel |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Signature Gold
via Fyremadel |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Everyday Bronze with Atrium Health
via Fyremadel |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Elite Bronze with Atrium Health
via Fyremadel |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Focused Silver with Atrium Health
via Fyremadel |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Complete Gold with Atrium Health
via Fyremadel |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Signature Expanded Bronze with Atrium Health
via Fyremadel |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Signature Silver with Atrium Health
via Fyremadel |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Signature Gold with Atrium Health
via Fyremadel |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Enhanced Asthma/COPD Care Silver $0 Rx Options + Vision + Adult Dental
via Fyremadel |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Complete Gold + Vision + Adult Dental
via Fyremadel |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Everyday Bronze + Vision + Adult Dental
via Fyremadel |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Elite Bronze + Vision + Adult Dental
via Fyremadel |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Everyday Bronze with Atrium Health + Vision + Adult Dental
via Fyremadel |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Elite Bronze with Atrium Health + Vision + Adult Dental
via Fyremadel |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Focused Silver with Atrium Health + Vision + Adult Dental
via Fyremadel |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Complete Gold with Atrium Health + Vision + Adult Dental
via Fyremadel |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Signature Expanded Bronze + Vision + Adult Dental
via Fyremadel |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Signature Silver + Vision + Adult Dental
via Fyremadel |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Signature Gold + Vision + Adult Dental
via Fyremadel |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Complete Gold
via Fyremadel |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Signature Silver with Atrium Health + Vision + Adult Dental
via Fyremadel |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Signature Gold with Atrium Health + Vision + Adult Dental
via Fyremadel |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Enhanced CHF Heart Care Silver $0 Rx Options
via Fyremadel |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Streamlined Silver with Atrium Health
via Fyremadel |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Streamlined Silver
via Fyremadel |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Clear Silver with $0 Insulin Options + Vision + Adult Dental
via Fyremadel |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Enhanced CHF Heart Care Silver $0 Rx Options + Vision + Adult Dental
via Fyremadel |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Complete Gold
via ganirelix acetate |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Enhanced Asthma/COPD Care Silver $0 Rx Options
via ganirelix acetate |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Everyday Bronze
via ganirelix acetate |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Elite Bronze
via ganirelix acetate |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Clear Silver with $0 Insulin Options
via ganirelix acetate |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Signature Expanded Bronze
via ganirelix acetate |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Signature Silver
via ganirelix acetate |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Signature Gold
via ganirelix acetate |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Everyday Bronze with Atrium Health
via ganirelix acetate |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Elite Bronze with Atrium Health
via ganirelix acetate |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Focused Silver with Atrium Health
via ganirelix acetate |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Complete Gold with Atrium Health
via ganirelix acetate |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Signature Expanded Bronze with Atrium Health
via ganirelix acetate |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Signature Silver with Atrium Health
via ganirelix acetate |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Signature Gold with Atrium Health
via ganirelix acetate |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Enhanced Asthma/COPD Care Silver $0 Rx Options + Vision + Adult Dental
via ganirelix acetate |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Complete Gold + Vision + Adult Dental
via ganirelix acetate |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Everyday Bronze + Vision + Adult Dental
via ganirelix acetate |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Elite Bronze + Vision + Adult Dental
via ganirelix acetate |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Everyday Bronze with Atrium Health + Vision + Adult Dental
via ganirelix acetate |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Elite Bronze with Atrium Health + Vision + Adult Dental
via ganirelix acetate |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Focused Silver with Atrium Health + Vision + Adult Dental
via ganirelix acetate |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Complete Gold with Atrium Health + Vision + Adult Dental
via ganirelix acetate |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Signature Expanded Bronze + Vision + Adult Dental
via ganirelix acetate |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Signature Silver + Vision + Adult Dental
via ganirelix acetate |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Signature Gold + Vision + Adult Dental
via ganirelix acetate |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Signature Expanded Bronze with Atrium Health + Vision + Adult Dental
via ganirelix acetate |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Signature Silver with Atrium Health + Vision + Adult Dental
via ganirelix acetate |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Signature Gold with Atrium Health + Vision + Adult Dental
via ganirelix acetate |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Enhanced CHF Heart Care Silver $0 Rx Options
via ganirelix acetate |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Streamlined Silver with Atrium Health
via ganirelix acetate |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Streamlined Silver
via ganirelix acetate |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Clear Silver with $0 Insulin Options + Vision + Adult Dental
via ganirelix acetate |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Enhanced CHF Heart Care Silver $0 Rx Options + Vision + Adult Dental
via ganirelix acetate |
Tier 5 - Specialty | ✓ | — | — | PA |
AmeriHealth Caritas NC
11 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
AmeriHealth Caritas Next Silver Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via ganirelix acetate |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Bronze Essential + Three Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via ganirelix acetate |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Bronze Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via ganirelix acetate |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Gold Copay Focus + $0 Deductible + Free PCP + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via ganirelix acetate |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Off-Marketplace Low + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via ganirelix acetate |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Gold Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via ganirelix acetate |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Essential + Two Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via ganirelix acetate |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Premier + No Referrals
via ganirelix acetate |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Bronze Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via ganirelix acetate |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Off-Marketplace High + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via ganirelix acetate |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Gold Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via ganirelix acetate |
Tier 5 - Specialty | ✓ | — | — | PA |
Blue Cross Blue Shield Federal
3 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
BCBS Federal Focus 2026
via ganirelix acetate |
Tier 2 - Preferred Brand | ✓ | — | — | PA |
|
BCBS Federal Standard Option 2026
via ganirelix acetate |
Tier 4 - Preferred Specialty | ✓ | — | — | PA |
|
BCBS Federal Basic Option 2026
via ganirelix acetate |
Tier 4 - Preferred Specialty | ✓ | — | — | PA |
Blue Cross Blue Shield of NC
5 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
BCBSNC Blue Value 2026
via ganirelix acetate |
Tier 2 - Medium Cost Generic/Brand | — | — | ✓ | QL |
|
BCBSNC Blue Home with UNC Health Alliance 2026
via ganirelix acetate |
Tier 2 - Medium Cost Generic/Brand | — | — | ✓ | QL |
|
BCBSNC Blue Local 2026
via ganirelix acetate |
Tier 2 - Medium Cost Generic/Brand | — | — | ✓ | QL |
|
BCBSNC Blue Care 2026
via ganirelix acetate |
Tier 2 - Medium Cost Generic/Brand | — | — | ✓ | QL |
|
BCBSNC Blue Advantage 2026
via ganirelix acetate |
Tier 2 - Medium Cost Generic/Brand | — | — | ✓ | QL |
NC State Health Plan
3 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| NC State Health Plan - HDHP 2026 | Not Covered | — | — | — | None |
| NC State Health Plan - 80/20 Plus PPO 2026 | Not Covered | — | — | — | None |
| NC State Health Plan - 70/30 Standard PPO 2026 | Not Covered | — | — | — | None |
UnitedHealthcare
17 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
UHC Bronze Standard (HSA, $0 Insulin, No Referrals)
via ganirelix acetate |
Tier 5 - Specialty | ✓ | — | — | PA |
|
UHC Silver Standard ($8 Tier 2 Rx, $0 Insulin, No Referrals)
via ganirelix acetate |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
UHC Bronze Essential ($0 Virtual Urgent Care, HSA, $0 Insulin, No Referrals)
via ganirelix acetate |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
UHC Gold Standard ($5 Tier 2 Rx, $0 Insulin, No Referrals)
via ganirelix acetate |
Tier 5 - Specialty | ✓ | — | — | PA |
|
UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals)
via ganirelix acetate |
Tier 5 - Specialty | ✓ | — | — | PA |
|
UHC Silver Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, $0 Insulin, Dental + Vision, No Referrals)
via ganirelix acetate |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
UHC Gold Copay Focus+ $0 Ded ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals)
via ganirelix acetate |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
UHC Bronze Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, HSA, $0 Insulin, Dental + Vision, No Referrals)
via ganirelix acetate |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
UHC Silver Value ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, No Referrals)
via ganirelix acetate |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
UHC Silver Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, $0 Insulin, No Referrals)
via ganirelix acetate |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
UHC Gold Advantage+ ($0 Virtual Urgent Care, $1 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals)
via ganirelix acetate |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
UHC Bronze Standard+ (HSA, $0 Insulin, Dental + Vision, No Referrals)
via ganirelix acetate |
Tier 5 - Specialty | ✓ | — | — | PA |
|
UHC Silver Value+ ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals)
via ganirelix acetate |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, $0 Insulin, No Referrals)
via ganirelix acetate |
Tier 5 - Specialty | ✓ | — | — | PA |
|
UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals)
via ganirelix acetate |
Tier 5 - Specialty | ✓ | — | — | PA |
|
UHC Gold Copay Focus $0 Ded ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, No Referrals)
via ganirelix acetate |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, HSA, $0 Insulin, No Referrals)
via ganirelix acetate |
Tier 5 - Specialty | ✓ | — | — | PA |